| NPI | 1013663640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH7304) |
| Additional Taxonomies | 385HR2055X Respite Care, Respite Care, Mental Illness, Child (Licence: AZ BH7304) |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2024-05-01 |